Outcome of relapsed adult lymphoblastic leukemia depends on response to salvage chemotherapy, prognostic factors, and performance of stem cell transplantation
Despite improvements in first-line therapies, published results on the treatment of relapsed adult acute lymphoblastic leukemia (ALL) show that prognosis is still poor. The aim of the present retrospective analysis of the German Multicenter Study Group for Adult ALL was to identify prognostic factor...
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| Veröffentlicht in: | Blood 2012-09, Vol.120 (10), p.2032-2041 |
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| creator | Gökbuget, Nicola Stanze, Daniel Beck, Joachim Diedrich, Helmut Horst, Heinz-August Hüttmann, Andreas Kobbe, Guido Kreuzer, Karl-Anton Leimer, Lothar Reichle, Albrecht Schaich, Markus Schwartz, Stefan Serve, Hubert Starck, Michael Stelljes, Matthias Stuhlmann, Reingard Viardot, Andreas Wendelin, Knut Freund, Mathias Hoelzer, Dieter |
| description | Despite improvements in first-line therapies, published results on the treatment of relapsed adult acute lymphoblastic leukemia (ALL) show that prognosis is still poor. The aim of the present retrospective analysis of the German Multicenter Study Group for Adult ALL was to identify prognostic factors and options for improvement. A total of 547 patients with a median age of 33 years (range, 15-55) experiencing their first relapse (406 vs 141 shorter or longer than 18 months from diagnosis) were evaluated. The aim of salvage therapy was to achieve a complete remission (CR) with subsequent a stem cell transplantation (SCT). The CR rate (assessed in Philadelphia chromosome– and BCR-ABL–negative ALL without CNS involvement) after the first salvage in relapse after chemotherapy (n = 224) was 42%. After failure of first salvage (n = 82), the CR rate after second salvage was 33%. In relapse after SCT (n = 48) the CR rate after first salvage was 23%. The median overall survival after relapse was 8.4 months and survival was 24% at 3 years. Prognostic factors for survival were relapse localization, response to salvage, performance of SCT, and age. Overall survival appeared superior compared with previously published studies, likely because of the high rate of SCT in the present study (75%). Further improvement may be achieved with earlier relapse detection and experimental approaches in early relapse. The study is registered at www.clinicaltrials.gov as NCT00199056 and NCT00198991. |
| doi_str_mv | 10.1182/blood-2011-12-399287 |
| format | Article |
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The aim of the present retrospective analysis of the German Multicenter Study Group for Adult ALL was to identify prognostic factors and options for improvement. A total of 547 patients with a median age of 33 years (range, 15-55) experiencing their first relapse (406 vs 141 shorter or longer than 18 months from diagnosis) were evaluated. The aim of salvage therapy was to achieve a complete remission (CR) with subsequent a stem cell transplantation (SCT). The CR rate (assessed in Philadelphia chromosome– and BCR-ABL–negative ALL without CNS involvement) after the first salvage in relapse after chemotherapy (n = 224) was 42%. After failure of first salvage (n = 82), the CR rate after second salvage was 33%. In relapse after SCT (n = 48) the CR rate after first salvage was 23%. The median overall survival after relapse was 8.4 months and survival was 24% at 3 years. Prognostic factors for survival were relapse localization, response to salvage, performance of SCT, and age. Overall survival appeared superior compared with previously published studies, likely because of the high rate of SCT in the present study (75%). Further improvement may be achieved with earlier relapse detection and experimental approaches in early relapse. The study is registered at www.clinicaltrials.gov as NCT00199056 and NCT00198991.</description><identifier>ISSN: 0006-4971</identifier><identifier>EISSN: 1528-0020</identifier><identifier>DOI: 10.1182/blood-2011-12-399287</identifier><identifier>PMID: 22493293</identifier><language>eng</language><publisher>Washington, DC: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Age Factors ; Antineoplastic Agents - administration & dosage ; Biological and medical sciences ; Biomarkers, Tumor - analysis ; Female ; Fusion Proteins, bcr-abl - analysis ; Hematologic and hematopoietic diseases ; Humans ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Male ; Medical sciences ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - diagnosis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy ; Recurrence ; Remission Induction ; Retrospective Studies ; Salvage Therapy ; Stem Cell Transplantation ; Survival Rate ; Treatment Outcome</subject><ispartof>Blood, 2012-09, Vol.120 (10), p.2032-2041</ispartof><rights>2012 American Society of Hematology</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c504t-a6c78037ce6841a26c26e5bab8b7aa3788a31fd091b0475281582a40f81a1ca93</citedby><cites>FETCH-LOGICAL-c504t-a6c78037ce6841a26c26e5bab8b7aa3788a31fd091b0475281582a40f81a1ca93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26324964$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22493293$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gökbuget, Nicola</creatorcontrib><creatorcontrib>Stanze, Daniel</creatorcontrib><creatorcontrib>Beck, Joachim</creatorcontrib><creatorcontrib>Diedrich, Helmut</creatorcontrib><creatorcontrib>Horst, Heinz-August</creatorcontrib><creatorcontrib>Hüttmann, Andreas</creatorcontrib><creatorcontrib>Kobbe, Guido</creatorcontrib><creatorcontrib>Kreuzer, Karl-Anton</creatorcontrib><creatorcontrib>Leimer, Lothar</creatorcontrib><creatorcontrib>Reichle, Albrecht</creatorcontrib><creatorcontrib>Schaich, Markus</creatorcontrib><creatorcontrib>Schwartz, Stefan</creatorcontrib><creatorcontrib>Serve, Hubert</creatorcontrib><creatorcontrib>Starck, Michael</creatorcontrib><creatorcontrib>Stelljes, Matthias</creatorcontrib><creatorcontrib>Stuhlmann, Reingard</creatorcontrib><creatorcontrib>Viardot, Andreas</creatorcontrib><creatorcontrib>Wendelin, Knut</creatorcontrib><creatorcontrib>Freund, Mathias</creatorcontrib><creatorcontrib>Hoelzer, Dieter</creatorcontrib><creatorcontrib>German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia</creatorcontrib><title>Outcome of relapsed adult lymphoblastic leukemia depends on response to salvage chemotherapy, prognostic factors, and performance of stem cell transplantation</title><title>Blood</title><addtitle>Blood</addtitle><description>Despite improvements in first-line therapies, published results on the treatment of relapsed adult acute lymphoblastic leukemia (ALL) show that prognosis is still poor. The aim of the present retrospective analysis of the German Multicenter Study Group for Adult ALL was to identify prognostic factors and options for improvement. A total of 547 patients with a median age of 33 years (range, 15-55) experiencing their first relapse (406 vs 141 shorter or longer than 18 months from diagnosis) were evaluated. The aim of salvage therapy was to achieve a complete remission (CR) with subsequent a stem cell transplantation (SCT). The CR rate (assessed in Philadelphia chromosome– and BCR-ABL–negative ALL without CNS involvement) after the first salvage in relapse after chemotherapy (n = 224) was 42%. After failure of first salvage (n = 82), the CR rate after second salvage was 33%. In relapse after SCT (n = 48) the CR rate after first salvage was 23%. The median overall survival after relapse was 8.4 months and survival was 24% at 3 years. Prognostic factors for survival were relapse localization, response to salvage, performance of SCT, and age. 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Myelofibrosis</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - diagnosis</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy</subject><subject>Recurrence</subject><subject>Remission Induction</subject><subject>Retrospective Studies</subject><subject>Salvage Therapy</subject><subject>Stem Cell Transplantation</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>0006-4971</issn><issn>1528-0020</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuO1DAURC0EYpqBP0DIGyQWE_AjnTgbpNGIlzTSbGBt3dg30wbHDrYzUv8M34r7AexY3c2puqUqQl5y9pZzJd6NPkbbCMZ5w0Ujh0Go_hHZ8K1QDWOCPSYbxljXtEPPL8iznL8zxlsptk_JhRDtIMUgN-TX3VpMnJHGiSb0sGS0FOzqC_X7ednF0UMuzlCP6w-cHVCLCwabaQxVkJcYMtISaQb_APdIzQ7nWHaYYNlf0SXF-xCPBhOYElO-ohAsXTBNMc0QzPFzLjhTg97TkiDkxUMoUFwMz8mTCXzGF-d7Sb59_PD15nNze_fpy831bWO2rC0NdKZXTPYGO9VyEJ0RHW5HGNXYA8heKZB8smzgI2v72hDfKgEtmxQHbmCQl-TNybcG_rliLnp2-RAIAsY1a85F14lecVnR9oSaFHNOOOkluRnSXnOmD8vo4zL6sIzmQp-WqbJX5w_rOKP9K_ozRQVenwHIBvxUizAu_-M6Wcmurdz7E4e1jweHSWfjsBZpXUJTtI3u_0l-A9DVsGo</recordid><startdate>20120906</startdate><enddate>20120906</enddate><creator>Gökbuget, Nicola</creator><creator>Stanze, Daniel</creator><creator>Beck, Joachim</creator><creator>Diedrich, Helmut</creator><creator>Horst, Heinz-August</creator><creator>Hüttmann, Andreas</creator><creator>Kobbe, Guido</creator><creator>Kreuzer, Karl-Anton</creator><creator>Leimer, Lothar</creator><creator>Reichle, Albrecht</creator><creator>Schaich, Markus</creator><creator>Schwartz, Stefan</creator><creator>Serve, Hubert</creator><creator>Starck, Michael</creator><creator>Stelljes, Matthias</creator><creator>Stuhlmann, Reingard</creator><creator>Viardot, Andreas</creator><creator>Wendelin, Knut</creator><creator>Freund, Mathias</creator><creator>Hoelzer, Dieter</creator><general>Elsevier Inc</general><general>Americain Society of Hematology</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120906</creationdate><title>Outcome of relapsed adult lymphoblastic leukemia depends on response to salvage chemotherapy, prognostic factors, and performance of stem cell transplantation</title><author>Gökbuget, Nicola ; Stanze, Daniel ; Beck, Joachim ; Diedrich, Helmut ; Horst, Heinz-August ; Hüttmann, Andreas ; Kobbe, Guido ; Kreuzer, Karl-Anton ; Leimer, Lothar ; Reichle, Albrecht ; Schaich, Markus ; Schwartz, Stefan ; Serve, Hubert ; Starck, Michael ; Stelljes, Matthias ; Stuhlmann, Reingard ; Viardot, Andreas ; Wendelin, Knut ; Freund, Mathias ; Hoelzer, Dieter</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c504t-a6c78037ce6841a26c26e5bab8b7aa3788a31fd091b0475281582a40f81a1ca93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Biomarkers, Tumor - analysis</topic><topic>Female</topic><topic>Fusion Proteins, bcr-abl - analysis</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Humans</topic><topic>Leukemias. 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The aim of the present retrospective analysis of the German Multicenter Study Group for Adult ALL was to identify prognostic factors and options for improvement. A total of 547 patients with a median age of 33 years (range, 15-55) experiencing their first relapse (406 vs 141 shorter or longer than 18 months from diagnosis) were evaluated. The aim of salvage therapy was to achieve a complete remission (CR) with subsequent a stem cell transplantation (SCT). The CR rate (assessed in Philadelphia chromosome– and BCR-ABL–negative ALL without CNS involvement) after the first salvage in relapse after chemotherapy (n = 224) was 42%. After failure of first salvage (n = 82), the CR rate after second salvage was 33%. In relapse after SCT (n = 48) the CR rate after first salvage was 23%. The median overall survival after relapse was 8.4 months and survival was 24% at 3 years. Prognostic factors for survival were relapse localization, response to salvage, performance of SCT, and age. Overall survival appeared superior compared with previously published studies, likely because of the high rate of SCT in the present study (75%). Further improvement may be achieved with earlier relapse detection and experimental approaches in early relapse. The study is registered at www.clinicaltrials.gov as NCT00199056 and NCT00198991.</abstract><cop>Washington, DC</cop><pub>Elsevier Inc</pub><pmid>22493293</pmid><doi>10.1182/blood-2011-12-399287</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Age Factors Antineoplastic Agents - administration & dosage Biological and medical sciences Biomarkers, Tumor - analysis Female Fusion Proteins, bcr-abl - analysis Hematologic and hematopoietic diseases Humans Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Male Medical sciences Middle Aged Precursor Cell Lymphoblastic Leukemia-Lymphoma - diagnosis Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy Recurrence Remission Induction Retrospective Studies Salvage Therapy Stem Cell Transplantation Survival Rate Treatment Outcome |
| title | Outcome of relapsed adult lymphoblastic leukemia depends on response to salvage chemotherapy, prognostic factors, and performance of stem cell transplantation |
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